Surgical treatment and outcome of iatrogenic bile duct lesions after cholecystectomy and the impact of different clinical classification systems

Background: Different injury patterns of iatrogenic bile duct lesions after cholecystectomy have prompted the proposal of several different clinical classification systems. The aim of this study was to validate these systems comparatively. Methods: Results after surgical intervention for iatrogenic bile duct lesions in 74 consecutive patients at a tertiary referral centre were reviewed retrospectively. A new classification (Hannover classification) for iatrogenic bile duct lesions is proposed and compared with four other systems using the present clinical data. Results: Additional vascular lesions were found in 19 per cent. The hospital mortality rate was 3 per cent and the overall hospital complication rate after repair was 26 per cent. Sixteen of 74 patients required early surgical reintervention. The Hannover classification demonstrated a highly significant association between the discrimination of classifiable injury patterns and the different surgical treatments chosen (P < 0.005). The Strasberg and Neuhaus classifications do not consider vascular involvement, whereas the Stewart-Way, Siewert and Neuhaus systems do not discriminate between lesions at or above the bifurcation of the hepatic duct. Conclusion: Additional vascular involvement and location of the lesion at or above the bifurcation of the hepatic duct have a major impact on the extent of surgical intervention required and should be reflected in any classification of bile duct injuries.